肺外结核^(18)F-FDGPET/CT显像的诊断价值  

Diagnostic value of ^(18)F-FDG PET/CT in extrapulmonary tuberculosis

作　　者：柳伟坤[1] 李向东[1] 尹吉林[1] 李兴耀[1] 王欣璐[1] 

机构地区：[1]广州军区广州总医院PET/CT中心,广东广州510010

出　　处：《南方医科大学学报》2013年第7期1083-1086,共4页Journal of Southern Medical University

基　　金：国家卫生部重大科研基金(W2009BX027)

摘　　要：目的探讨18F-FDG PET/CT显像对肺外结核的诊断价值,以提高早期诊断率。方法回顾性分析2005年08月～2011年05月期间在我院行18F-FDG PET/CT显像的88例肺外结核病患者资料,其中8例做同机增强CT扫描。结果 88例患者中合并有肺内结核的有22例,共发现病灶334处。所有病灶均表现为18F-FDG不同程度摄取,SUVmax介于1.3～23.2之间,其中19例误诊为恶性肿瘤。根据发病部位大致可分为4大类:⑨"膜性"结核(36例),主要表现为胸膜、心包、腹膜等不同程度增厚,仅6例未见明显增厚;⑨淋巴结结核(44例)。表现为不同程度增大淋巴结影,22例边缘模糊,3例见中心坏死,6例CT增强可见环形强化;⑨骨关节结核(28例)。主要表现为溶骨性骨质破坏,伴或不伴有骨质硬化;脊柱结核以椎间盘受累及冷脓肿形成为主要特点;其中,仅1例表现为FDG高摄取而无骨质破坏;⑨脏器结核(25例)。肝、脾、胰腺、肾、脑结核主要表现为低密度影,3例增强扫描呈环形强化;鼻咽及喉结核主要表现为软组织增厚;肠结核表现为肠壁稍增厚,2例表现为多发节段性增厚。88例肺外结核患者中,30例含有前述2类或2类以上病变。结论 PET/CT能较准确显示肺外结核的病灶形态、范围及活动性,为肺外结核的早期诊断和治疗提供帮助。CT增强扫描可起到一定的鉴别作用。Objective To explore the value of 18 F-FDG PET/CT in the diagnosis of extrapulmonary tuberculosis （ET）. Methods The imaging data from 88 cases of ET undergoing 18F- FDG PET/CT examinations between August, 2005 and May, 2011 were analyzed retrospectively. Results All the 88 cases showed high 18 F-FDG uptake on PET imaging with a SUVmax ranging from 1.3 to 23.2. In 19 of the 88 cases, the extrapulmonary lesions were misdiagnosed as malignant neoplasms. Twenty-two patients were found to have phthisis. According to locations, the lesions were classified into 4 basic types, namely membranous tuberculosis （36 cases） with soft tissue thickening as the main manifestation （only 6 cases did not present with obvious thickening）, lymphatic tuberculosis （44 cases） with lymph node enlargement （ill-defined edge in 22 cases, central necrosis in 3 cases, and ring-like enhancement in enhanced CT scan in 6 cases）, osteoarticular tuberculosis （ 28 cases） with the main findings of osteolytic destruction with or without osteosclerosis （tuberculosis of the spine was characterized by disc damage and paravertebral cold abscess; only one case showed high FDG uptake without bone destruction）, and organ tuberculosis （25 cases） involving the liver, spleen, pancreas, kidney and brain, where lesions of low density were detected in CT scan （3 cases showed ring-like enhancement）. In cases of organ tuberculosis, nasopharyngeal and laryngeal tuberculosis showed soft tissue thickening, and intestinal tuberculosis presented with slight intestinal wall thickening （involving multiple segments in 2 cases）. Of the 88 cases, 30 had two or more than two lesion types. Conclusion PET/CT can accurately demonstrate the morphology, extent of involvement and uptake activity of the ET lesions to assist the early diagnosis and treatment of ET. Enhanced CT scan also helps in the differential diagnosis of the lesions.

关 键 词：结核病 肺外结核 18F-FDG PET CT 

分 类 号：R52[医药卫生—内科学]